ConnRex Intake Form – connmediadigitalorders.com

If you are not ready to submit, select the “Save & Continue” option at the bottom of the form and you’ll receive a special link to return to your work.

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X/Twitter

This field is for validation purposes and should be left unchanged.

Market*

AM Email*

OS Email*

AE Name*

AE Email Address*

DSM's Email Address*

Client Business Name*

Please spell out the company name, no abbreviations.

Client Name*

Client Email*

Client Phone Number*

Client Website*

If your client has no website and is requesting a new build, put N/A

GTM ID*

Put N/A if none

Emails to Receive Reporting*

Total Tactic Investment for entire campaign duration, NOT per month*

Total Creative Fees for entire campaign duration, NOT per month*

Is this Co-op that has to be Flighted Monthly?*

**PLEASE MAKE SURE THE PROPOSAL IS SET UP FOR FLIGHTS**

YES

Is this a political campaign?*

Political form must be submitted before the order can be processed

YES

Flight or MRR

Intake Form

Submission Date*

Today’s date

Flight Campaign Start Date*

Flight Campaign End Date*

MRR Start Month*

MRR Start Week*

Select your Branding & Awareness Services:

Targeted Display

Weather Trigger

Geo Fencing

Geo Fencing Pre Roll

Smart Social Meta

Social Mirroring

Video

Digital Audio

Select your Lead Gen Services:

Lead Gen Ads

Select your SEO Services:

Search Engine Optimization

TARGETED DISPLAY

Do the run dates differ from the overall order?*

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Display Start Date

Display End Date

Targeting Options*

Choose One

Total Budget

This field will populate automatically when you fill out the impression goal above.

Total Impressions*

Enter the total for the entire flight/date range, not per month.

Is our design team making the creatives?*

Yes

Do You Need a Retargeting Pixel*

Yes

Does the proposal include Purple Labs Data*

If yes, please ensure the market chooses segments from the Google sheet.

Yes

Purple Labs Segments*

Please list the Segments below

Display CTURL/UTM*

Geography*

Define the geography you want your advertising to serve within – state, region, city, or zip codes or a radius around a location.

Audience:*

Please list Audience from Builder and any other additional nots

Campaign Goals – OPTIONAL

For example, Brand Awareness, Relevance in Search Results, Improve Online Reputation, increase Website Visits, or promote a special event, sale or promotion.

Additional Notes – OPTIONAL

Weather Trigger

Is the Weather Trigger form filled out?*

This form must be filled out before submitting to the Programmatic Team

yes

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Weather Trigger Start Date

Weather Trigger End Date

Total Weather Trigger Budget

Enter the total for the entire flight/date range, not per month.

Total Weather Trigger Impressions*

Weather Trigger CTURL/UTM*

Geofencing Link*

Weather Trigger Form Link*

Geography*

Define the geography you want your advertising to serve within – state, region, city, or zip codes or a radius around a location.

Audience:*

Please list Audience from Builder and any other additional nots

Campaign Goals – OPTIONAL

For example, Brand Awareness, Relevance in Search Results, Improve Online Reputation, increase Website Visits, or promote a special event, sale or promotion.

Additional Notes – OPTIONAL

GEO FENCING

Geo-Fencing Restrictions The following locations can no longer be geo-fenced: K–12 schools, Government buildings, including City Hall, courthouses, jails, and military bases. Medical Targeting requires a minimum 1-mile radius—including any business that references medical services on their Google Business page, such as med spas or weight loss clinics

Is this Co-op that has to be Flighted Monthly?*

**PLEASE MAKE SURE THE PROPOSAL IS SET UP FOR FLIGHTS**

YES

Geo Fencing Options*

Geofence w/FTA

Geofence w/o FTA

Geofencing w/o FTA (Sensitive)

Historical Location Targeting w/FTA

Political Addressable Display Geofencing

Geofence w/FTA

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Geofence w/FTA Start Date

Geofence w/FTA EndDate

Total Geofence w/FTA Budget*

Enter the total for the entire flight/date range, not per month.

Total Geofence w/FTA Impressions*

Enter the total for the entire flight/date range, not per month.

Geofence w/FTA CTURL/UTM*

Geofence w/FTA Link*

Link to Template for target fences

Geofence w/o FTA

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Geofence w/o FTA Start Date

Geofence w/o FTA EndDate

Total Geofence w/o FTA Budget*

Enter the total for the entire flight/date range, not per month.

Total Geofence w/o FTA Impressions*

Enter the total for the entire flight/date range, not per month.

Geofence w/o FTA CTURL/UTM*

Geofence w/o FTA Link*

Link to Template for target fences

Geofence w/o FTA (sensitive)

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Geofence w/o FTA (sensitive) Start Date

Geofence w/o FTA (sensitive) End Date

Total Geofence w/o FTA (sensitive) Budget*

Enter the total for the entire flight/date range, not per month.

Total Geofence w/o FTA (sensitive) Impressions*

Enter the total for the entire flight/date range, not per month.

Geofence w/o FTA (sensitive) CTURL/UTM*

Geofence w/o FTA (sensitive) Link*

Link to Template for target fences

Historical Location Targeting w/FTA

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Historical Location Targeting w/FTA Start Date

Historical Location Targeting w/FTA End Date

Total Historical Location Targeting w/FTA Budget*

Enter the total for the entire flight/date range, not per month.

Total Historical Location Targeting w/FTA Impressions*

Enter the total for the entire flight/date range, not per month.

Historical Location Targeting w/FTA CTURL/UTM*

Historical Location Geofence Link*

Link to Template for target fences

Political Addressable Geofencing

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Political Addressable Geofencing Start Date

Political Addressable Geofencing End Date

Political Form Submitted?*

Form must be submitted before the order can be processed

Yes

Total Political Addressable Geofencing Budget*

Enter the total for the entire flight/date range, not per month.

Total Political Addressable Geofencing Impressions*

Enter the total for the entire flight/date range, not per month.

Political Addressable Geofencing CTURL/UTM*

Political Addressable Geofence Link*

Link to Template for customer addresses

Geography*

Define the geography you want your advertising to serve within – state, region, city, or zip codes or a radius around a location.

Describe Your Audience (Interests, Demographics, etc)*

Campaign Goals

For example, Brand Awareness, Relevance in Search Results, Improve Online Reputation, increase Website Visits, or promote a special event, sale or promotion.

Please add any special instructions/notes here.

GEO FENCING PRE ROLL

Geo Fencing Pre Roll Options*

Geofence w/FTA

Geofence w/o FTA

Geofencing w/o FTA (Sensitive)

Historical Location Targeting w/FTA

Political Addressable Geofencing

Geofence Pre Roll w/FTA

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Geofence Pre Roll w/FTA Start Date

Geofence Pre Roll w/FTA End Date

Total Geofence w/FTA Budget*

Enter the total for the entire flight/date range, not per month.

Total Geofence w/FTA Impressions*

Enter the total for the entire flight/date range, not per month.

Geofence w/FTA CTURL/UTM*

Geofence w/FTA Link*

Link to Template for target fences

Geofence Pre Roll w/o FTA

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Geofence Pre Roll w/o FTA Start Date

Geofence Pre Roll w/o FTA End Date

Total Geofence w/o FTA Budget*

Enter the total for the entire flight/date range, not per month.

Total Geofence w/o FTA Impressions*

Enter the total for the entire flight/date range, not per month.

Geofence w/o FTA CTURL/UTM*

Geofence w/o FTA Link*

Link to Template for target fences

Geofence Pre Roll w/o FTA (sensitive)

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Geofence Pre Roll w/o FTA (sensitive) Start Date

Geofence Pre Roll w/o FTA (sensitive) End Date

Total Geofence w/o FTA (sensitive) Budget*

Enter the total for the entire flight/date range, not per month.

Total Geofence w/o FTA (sensitive) Impressions*

Enter the total for the entire flight/date range, not per month.

Geofence w/o FTA (sensitive) CTURL/UTM*

Geofence w/o FTA (sensitive) Link*

Link to Template for target fences

Historical Location Pre Roll Targeting w/FTA

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Historical Location Pre Roll Start Date

Historical Location Pre Roll End Date

Date

Total Historical Location Targeting w/FTA Budget*

Enter the total for the entire flight/date range, not per month.

Total Historical Location Targeting w/FTA Impresssions*

Enter the total for the entire flight/date range, not per month.

Historical Location Targeting w/FTA CTURL/UTM*

Historical Location Targeting w/FTA Link*

Link to Template for target fences

Political Addressable Geofencing Pre Roll

Political Form Submitted?*

Form must be submitted before order can be processed

Yes

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Political Addressable Start Date

Political Addressable End Date

Total Political Addressable Geofencing Budget*

Enter the total for the entire flight/date range, not per month.

Total Political Addressable Geofencing Impressions*

Enter the total for the entire flight/date range, not per month.

Political Addressable Geofencing CTURL/UTM*

Political Addressable Geofencing Link*

Link to Template for customer addresses

Geography*

Define the geography you want your advertising to serve within – state, region, city, or zip codes or a radius around a location.

Describe Your Audience (Interests, Demographics, etc)*

Campaign Goals

For example, Brand Awareness, Relevance in Search Results, Improve Online Reputation, increase Website Visits, or promote a special event, sale or promotion.

Please add any special instructions/notes here.

Smart Social Meta

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Smart Social Start Date

Smart Social End Date

Facebook Business Page URL*

Facebook Access*

Leadsie Link/Direct Access

Fulfillment Profile

Total Smart Social Meta Budget*

Smart Social Impressions*

Enter the total for the entire flight/date range, not per month.

Targeting*

Geofencing Device IDs

Facebook Audiences

Custom Customer List

Geo Fencing Address Link*

Put N/A if you do not have the link at the time of the order. Please submit directly into the task

Smart Social CTURL/UTM*

Geography*

Describe Your Audience (Interests, Demographics, etc)*

Please add any special instructions/notes here.

Who's Providing The Ad Copy?*

Customer

Connrex Team

Facebook Ad Copy*

Text: 90 characters
Headline: 25 characters
Link description: 30 characters

Social Mirroring

Social Mirroring*

Social Mirroring Display

Social Mirroring Pre-Roll

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Social Mirroring Display Start Date*

Social Mirroring Display End Date*

Total Social Mirroring Display Budget*

Total Number of Social Mirroring Impresions*

Social Mirroring Display CTURL/UTM*

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Social Mirroring Display Start Date*

Social Mirroring Display End Date*

Total Social Mirroring Pre-Roll Budget*

Total Social Mirroring Pre-Roll Impressions*

Social Mirroring Pre-Roll CTURL/UTM*

Link for Ad Creation*

If still waiting for post link just put N/A and send it directly in the task

Geography*

Define the geography you want your advertising to serve within – state, region, city, or zip codes or a radius around a location.

Describe Your Audience (Interests, Demographics, etc)*

Please add any special instructions/notes here.

VIDEO

Is this Co-op that has to be Flighted Monthly?*

**PLEASE MAKE SURE THE PROPOSAL IS SET UP FOR FLIGHTS**

YES

Using a Dynamic VAST Tag?*

Yes

Video Campaign Options*

Video Blend

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Video Blend Start Date*

Video Blend End Date*

Total Video Blend Budget*

Enter the total for the entire flight/date range, not per month.

Total Video Blend Impressions*

Enter the total for the entire flight/date range, not per month.

Video Blend CTURL/UTM*

Video Pre Roll

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Video Pre Roll Start Date*

Total Video Pre-Roll Budget*

Enter the total for the entire flight/date range, not per month.

Total Video Pre-Roll Impressions*

Enter the total for the entire flight/date range, not per month.

Video Pre-Roll CTURL/UTM*

Performance TV

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Performance TV Start Date*

Performance TV End Date*

Total Performance TV Budget*

Enter the total for the entire flight/date range, not per month.

Total Performance TV Impression*

Enter the total for the entire flight/date range, not per month.

Performance TV CTURL/UTM*

CTV Value

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

CTV Value Start Date*

CTV Value End Date*

Total CTV Value Budget*

Enter the total for the entire flight/date range, not per month.

Total CTV Value Impressions*

Enter the total for the entire flight/date range, not per month.

CTV Value CTURL/UTM*

CTV Premium

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

CTV Premium Start Date*

CTV Premium End Date*

Total CTV Premium Budget*

Enter the total for the entire flight/date range, not per month.

Total CTV Premium Impressions*

Enter the total for the entire flight/date range, not per month.

CTV Premium CTURL/UTM*

CTV Hulu Only

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

CTV Hulu Only Start Date*

CTV Hulu Only End Date*

Total CTV Hulu Only Budget*

Enter the total for the entire flight/date range, not per month.

Total CTV Hulu Only Impressions*

Enter the total for the entire flight/date range, not per month.

CTV Hulu Only CTURL/UTM*

CTV Spanish

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

CTV Spanish Start Date*

CTV Spanish End Date*

Total CTV Spanish Budget*

Enter the total for the entire flight/date range, not per month.

Total CTV Spanish Impressions*

Enter the total for the entire flight/date range, not per month.

CTV Spanish CTURL/UTM*

CTV Ultra

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

CTV Ultra Start Date*

CTV Ultra End Date*

Total CTV Ultra Budget*

Enter the total for the entire flight/date range, not per month.

Total CTV Ultra Impressions*

Enter the total for the entire flight/date range, not per month.

CTV Ultra CTURL/UTM*

Peacock Only

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Peacock Only Start Date*

Peacock Only End Date*

Total Peacock Only Budget*

Enter the total for the entire flight/date range, not per month.

Total Peacock Only Impressions*

Enter the total for the entire flight/date range, not per month.

Peacock Only CTURL/CTV*

Political CTV/OTT

Political Form Completed*

Yes

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Political CTV/OTT Start Date*

Political CTV/OTT End Date*

Total Political CTV/OTT Budget*

Enter the total for the entire flight/date range, not per month.

Total Political CTV/OTT Impressions*

Enter the total for the entire flight/date range, not per month.

Political CTV/OTT CTURL/UTM*

Pure Netflix

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Pure Netflix Start Date*

Pure Netflix End Date*

Total Pure Netflix Budget*

Enter the total for the entire flight/date range, not per month.

Total Pure Netflix Impressions*

Enter the total for the entire flight/date range, not per month.

Pure Netflix CTURL/UTM*

Reach CTV – Agriculture

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Reach CTV – Agriculture Start Date*

Reach CTV – Agriculture End Date*

Total Reach CTV – Agriculture Budget*

Enter the total for the entire flight/date range, not per month.

Total Reach CTV – Agriculture Impressions*

Enter the total for the entire flight/date range, not per month.

Reach CTV – Agriculture CTURL/UTM*

YouTube TV

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

YouTube TV Start.Date*

YouTube TV End Date*

Total YouTube TV Budget*

Enter the total for the entire flight/date range, not per month.

Total YouTube TV Impressions*

Enter the total for the entire flight/date range, not per month.

YouTube TV CTURL/UTM*

Sports CTV

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Sports CTV Start Date*

Sports CTV End Date*

Total Sports CTV Budget*

Enter the total for the entire flight/date range, not per month.

Total Sports CTV Impressions*

Enter the total for the entire flight/date range, not per month.

Sports CTV CTURL/UTM*

Amazon OTT Premium with Prime

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Amazon OTT Start Date*

Amazon OTT End Date*

Total Amazon OTT Budget*

Enter the total for the entire flight/date range, not per month.

Total Amazon OTT Impressions*

Enter the total for the entire flight/date range, not per month.

Amazon OTT CTURL/UTM*

Geography*

Define the geography you want your advertising to serve within – state, region, city, or zip codes or a radius around a location.

Describe your Audience (demographics, behaviors, etc)

Please add any special instructions/notes here.

DIGITAL AUDIO

Digital Audio Option*

Performance Audio

Political

Streaming Audio and Podcast Audio

Performance Audio

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Performance Audio Start Date*

Performance Audio End Date*

Performance Audio Total Budget*

Total Budget (Not Monthly)

Performance Audio Total Impressions*

Co-op flighted monthly, please list in the notes

Performance Audio CTURL/UTM*

Political Audio

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Political Audio Start Date*

Political Audio End Date*

Political Audio Total Budget*

Total Budget (Not Monthly)

Political Total Impressions*

Political CTURL/UTM*

Streaming Audio and Podcast

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Streaming Audio and Podcast Start Date*

Streaming Audio and Podcast End Date*

Total Streaming Audio and Podcast Budget

Total Budget (Not Monthly)

Total Streaming Audio and Podcast Impressions

Co-op flighted monthly, please list in the notes

Streaming Audio and Podcast CTURL/UTM

Geography*

Define the geography you want your advertising to serve within – state, region, city, or zip codes or a radius around a location.

Describe your Audience (demographics, behaviors, etc)

Please add any special instructions/notes here.

Lead Gen

Remember to have the What Connects tracking set up prior to submitting this form to the Lead Gen Team

Do the run dates differ from the overall order?

Choose “yes” if this specific tactic has run dates that are different from the overall order.

Lead Gen Start Date

Lead Gen End Date

Destination URL*

If the client is providing multiple services, please list out the pages that each service should go to if there are applicable pages for each.

Do you have a Google Search Console account?

Search Console is a tool also produced by Google that lets us know if your website is up to best practices. It also provides us with keywords that people are searching for that are relevant to your business. If you do not already have an account, we will set one up for you on your behalf.

Yes

Do you have a Google Analytics account?

Google analytics is a Google produced tool that allows us to look at how much traffic is getting to your website and by what mechanism (i.e. links, searches, blogs, etc). It allows us to see how people are getting to your site and what they are doing. – If Yes, please provide Leadsie Link

Yes

GA4 ID*

Geography*

If you have not already provided geographic targeting, is there a specific list of towns we should be targeting?

Target Products & Services*

What are the types of product and services you would like to come up for? Are there any that are priority over others?

Landing Page URLs*

If the client is providing multiple services, please list out the pages that each service should go to if there are applicable pages for each.

Unique Selling Propositions & Offers

What are some things that set you apart from your competition? Are there any offers we can highlight in our ads? We find that special offers and promotions can help set you apart from your competition and obtain more conversions and we will use this information to create the ad copy. List out 3-5 short phrases or call outs that will fit within Google Ad copy.

Any overall campaign notes

Destination Number

This is your opportunity to explain Dynamic Number Insertion call tracking – what it is, how it works, and why we use it.

Total Ad Spend*

Please include the TOTAL Lead Gen Ad spend across all Lead Gen Products

Advertising Platforms*

Check all that apply

Google Ads

Performance Max

Meta Lead Ads

Google Ads

Monthly Google Ad Spend*

Google CID*

Please list the CID even if access was granted through Leadsie – Sometimes they names will not match. If no CID – Please assign to Mike to create **If they are running Performance Max, it will be the same CID**

Negative Keywords*

Is there anything the customer does not want to show up for? For example, if you were a plumber but did not to emergency service, we would set “emergency service” as a negative keyword.

Performance Max

Monthly Performance Max Ad Spend*

Google CID*

Please list the CID even if access was granted through Leadsie – Sometimes they names will not match. If no CID – Please assign to Mike to create **If they are running Google ads, it will be the same CID**

YouTube Page URL*

YouTube Video Ad Link*

Negative Keywords*

Is there anything you do not want to show up for? For example, if you were a plumber but did not to emergency service, we would set “emergency service” as a negative keyword.

Describe The Audience*

Used to help create the Audience Signals

Competitor URLs*

Please provide 4-5 URLs to competitor websites

Meta Lead Ads

Monthly Meta Ad Spend*

Is the Meta Creative Tech Fee on the contract?*

If the fee is not included we will not use an integration to send their Leads to a CRM or provide the creative. If they have not selected this, the customer will need to provide creatives.

Yes

Do We have ADMIN access to the page through the Leadsie Link??*

We need admin access to set up the lead cards

Yes

Facebook Page URL*

If we were unable to get access to the page through Leadise, please get page URL so that the team can request access

Their website has to have a privacy policy in order to use the lead cards

Meta Pixel ID

If the customer does not have a Pixel ID, provide them instructions to create one then provide it in the task.

Meta Demographics Info*

Are there any demographic details that could be helpful for us to create a FB audience? For example: Gender, Age, Household Income, Education, Relationship Status, Parental Status, Home ownership Status.

Are there any other interests or Criteria relevant to your target audience?*

A few examples: What publications does their target audience read? What job titles may their target audience have? If B2B, what is the company size they are trying to reach (number of employees, revenue)?

Do They have a customer list they want to provide*

If yes, please attach to the task

Yes

Search Engine Optimization

Choose SEO Service Sold

Custom SEO

Local Regional SEO

IT/Web Dev*

Do you have an IT Team member or someone else in your organization that we would work with on grant access to the platforms needed?

IT/Web Dev Name*

IT/Web Dev Phone Number*

CMS System*

What Platform was used to build the site

WordPress

Drupal

Joomla

Other

CMS User Name*

CMS Password*

Who is hosting the site?*

Go Daddy. Host Data, Blue Host, etc. Need the company name.

Hosting Username*

Hosting Password*

Type of Business*

Service Areas*

Services Offered*

Why should a customer choose you over your competitors?*

Why would a customer choose a competitor over you? (Your company’s strengths and weaknesses.)*

Please select the 5 services that you would like to target organically.*

(Additional Service is $165/Month):

Select either 3 Cities OR 2 Cities and a County To Target*

(Additional City is $165/Month, Additional County $499/month)

Do we need your permission to make changes to your website for SEO purposes?*

Yes

Other

Additional SEO Notes

Date